Contrary to public perception, the need to do revisions in rhinoplasty surgery is not uncommon. One reason is that rhinoplasty surgery is not easy. In my opinoin, it is the most challenging of all cosmetic changes that are attempted on the face. And the way tissues heal and shrink after surgery is not always predictable which can cause undesired results in even the best performed rhinoplasty.

Historially, rhinoplasty surgery was performed in a 'closed' fashion, meaning work was done by looking up inside the nose. Seeing up through the nostrils is difficult, whether you are a plastic surgeon or not...and do exacting work on its delicate structures. As a result, the need for a second surgery after an initial rhinoplasty using a closed approach was not low, averaging a rate of 10% to 20% if not higher. It took a lot of years and a lot of rhinoplasty surgery cases to become really good at it. In other words, the learning curve was long and steep.

In contemporary rhinoplasty, improved methods have resulted in lower revision rates down around 5% or less. One of these newer methods is the conversion to the 'open' approach, meaning the skin is peeled back and the structures of the nose can be widely seen. The concept of peeling the skin off of the nose sounds horrifying to many patients. And justifiably so. But the reality is this is all done using just a tiny incision at the midway point of the skin between the nostrils. Scar healing in this small area does well with a near inconspicuous scar in almost all patients. This is a very small price to pay for improved rhinoplasty results. ASccuracy and predictability of results are improved when you can see clearly what you are doing.

As a result of using the open rhinoplasty approach, the changing of the shape of the tip cartilages has become much more predictable. The tip can be sculpted better with less removal or destruction of the tip support as was more commonly done with the closed approach.